Prosthetic valve support structure

ABSTRACT

The present invention is directed to prostheses including a support structure having a proximal end and a distal end, and a motion limiting member attached to the distal end of the support structure, wherein the motion limiting member is configured to restrict radial expansion of the distal end of the support structure. Methods for delivering the prosthesis are also provided.

RELATED APPLICATION DATA

This application claims priority to U.S. Provisional Patent ApplicationNo. 61/379,115, filed Sep. 1, 2010.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates to prosthetic valves and methods for theirimplantation. More particularly, the present invention provides forprosthetic valve support structures configured for transcatheterdelivery.

Background

Aortic valve replacement in patients with severe valve disease is acommon surgical procedure. The replacement is conventionally performedby open heart surgery, in which the heart is usually arrested and thepatient is placed on a heart bypass machine. Prostheses includingprosthetic heart valves have been developed that are implanted usingminimally invasive procedures such as transapical or percutaneousapproaches. These methods involve compressing the prosthesis radially toreduce its diameter, inserting the prosthesis into a delivery tool, suchas a catheter, and advancing the delivery tool to the correct anatomicalposition in the heart. Once properly positioned, the prosthesis isdeployed by radial expansion within the native valve annulus.

Such a prosthesis can include a support structure to maintain theprosthetic heart valve in place. The inflow section of the prosthesiscan be subject to radial interference from a body lumen, such as theleft ventricular outflow tract (LVOT), that can exert circumferentialradial pressure on the prosthesis. Such radial interference at an inflowsection of the prosthesis can result in radial movement at an outflowsection of the prosthesis. Such movement may be undesirable.

Moreover, a prosthesis can be subject to radial movement at an inflowsection, due to, for example, valve function and cardiac contraction.Such radial movement can cause the diameter of the inflow section toexperience cyclical contraction and expansion. Such contraction andexpansion can subject the prosthesis to unnecessary fatigue.

Additionally, due to less than perfect conformance between thegeometries of a patient's anatomy and the prosthesis, paravalvularleakage can occur. For example, a major course of leakage between aprosthesis and the LVOT wall is due to spaces created between scallopedleaflets called inter-leaflet triangles.

Accordingly, there is a need for a prosthesis that provides decoupledradial motion of the outflow section and the inflow section, and thatbetter conforms to a patient's anatomy.

PCT Publication No. WO 05/002466 to Schwammenthal et al., which isincorporated herein by reference in its entirety, describes prostheticdevices for treating aortic stenosis.

PCT Publication No. WO 06/070372 to Schwammenthal et al., which isincorporated herein by reference in its entirety, describes a prostheticdevice having a single flow field therethrough, adapted for implantationin a subject, and shaped so as to define a fluid inlet, and a divergingsection, distal to the fluid inlet.

US Patent Application Publication No. 2006/0149360 to Schwammenthal etal., which is incorporated herein by reference in its entirety,describes a prosthetic device including a valve-orifice attachmentmember attachable to a valve in a blood vessel and including a fluidinlet, and a diverging member that extends from the fluid inlet, thediverging member including a proximal end near the fluid inlet and adistal end distanced from the proximal end. A distal portion of thediverging member has a larger cross-sectional area for fluid flowtherethrough than a proximal portion thereof.

US Patent Application Publication No. 2006/0259136 to Nguyen et al.,which is incorporated herein by reference, describes a heart valveprosthesis having a self-expanding multi-level frame that supports avalve body including a skirt and plurality of coapting leaflets. Theframe transitions between a contracted delivery configuration thatenables percutaneous transluminal delivery, and an expanded deployedconfiguration having an asymmetric hourglass shape. The valve body skirtand leaflets are constructed so that the center of coaptation can beselected to reduce horizontal forces applied to the commissures of thevalve, and to efficiently distribute and transmit forces along theleaflets and to the frame. Alternatively, the valve body can be used asa surgically implantable replacement valve prosthesis.

BRIEF SUMMARY OF THE INVENTION

The present invention provides a valve prosthesis support structure thatlimits radial motion at a distal end thereof.

The present invention also provides a valve prosthesis support structurethat limits radial motion at a proximal end thereof.

The present invention also provides a valve prosthesis support structurethat includes sealing members to prevent paravalvular leakage.

The present invention provides a prosthesis including a supportstructure having a proximal end and a distal end, and a motion limitingmember attached to the distal end of the support structure, wherein themotion limiting member is configured to restrict radial expansion of thedistal end of the support structure.

The present invention also provides a valve prosthesis supportstructure, including a collapsible and expandable support structureincluding a plurality of posts at a distal end thereof and a flaredportion extending in a proximal direction from the plurality of posts,and a motion limiting member attached to a proximal end of the proximalskirt, wherein the motion limiting member is configured to restrictradial movement of the proximal end of the collapsible supportstructure.

The present invention also provides a method of delivering a prosthesisto a desired location in a body. One such method includes introducing asheath of a delivery system into a subject's vasculature, wherein adistal tip of the sheath contains the prosthesis, advancing the distaltip of the sheath to the desired location in the body, and releasing theprosthesis within the body, wherein the prosthesis includes a supportstructure having a proximal end and a distal end, and a motion limitingmember attached to the distal end of the support structure.

Additional features of the invention will be set forth in thedescription that follows. Both the foregoing general description and thefollowing detailed description are exemplary and explanatory and areintended to provide further explanation of the invention as claimed.

BRIEF DESCRIPTION OF THE FIGURES

The accompanying figures, which are incorporated herein, form part ofthe specification and illustrate exemplary embodiments of the presentinvention. Together with the description, the figures further serve toexplain the principles of and to enable a person skilled in the relevantart(s) to make and use the exemplary embodiments described herein. Inthe drawings like reference characters indicate identical orfunctionally similar elements.

FIG. 1 is a perspective view of a valve prosthesis subject to radialinterference at a proximal end.

FIG. 2 is a perspective view of a valve prosthesis not subject to radialinterference at a proximal end.

FIG. 3 is a perspective view of a valve prosthesis according to anembodiment of the present invention.

FIG. 4 is a top schematic view of the valve prosthesis of FIG. 3 .

FIG. 5 is a perspective view of a valve prosthesis according to anembodiment of the present invention.

FIG. 6 is a side schematic view of the valve prosthesis of FIG. 5 .

FIG. 7 is a perspective view of a valve prosthesis according to anembodiment of the present invention.

FIG. 8 is a top schematic view of the valve prosthesis of FIG. 7 .

FIG. 9 is a perspective view of a valve prosthesis according to anembodiment of the present invention.

FIG. 10 is a side schematic view of the valve prosthesis of FIG. 10 .

FIG. 11 is a perspective view of a valve prosthesis according to anembodiment of the present invention.

FIG. 12 is a perspective view of a valve prosthesis according to anembodiment of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The following detailed description of the present invention refers tothe accompanying figures that illustrate exemplary embodiments. Otherembodiments are possible and may fall within the scope of the presentinvention. Modifications can be made to the exemplary embodimentsdescribed herein without departing from the spirit and scope of thepresent invention. Therefore, the following detailed description is notmeant to be limiting. The operation and behavior of the exemplaryembodiments presented are described with the understanding that variousmodifications and variations of the exemplary embodiments may be withinthe scope of the present invention.

FIG. 1 is a perspective view of a valve prosthesis 100 subject to radialinterference at a proximal end. Radial interference can constrain orcause a change in the diameter of a portion of valve prosthesis 100.FIG. 2 is a perspective view of valve prosthesis 100 not subject toradial interference at a proximal end. Valve prosthesis 100 includes aninflow section 110 at a proximal end thereof, and an outflow section 120at a distal end thereof. Valve prosthesis 100 also includes a valveprosthesis support structure 130.

Valve prosthesis support structure 130 includes posts 122 (also referredto as commissural posts) proximate to outflow section 120, and aproximal skirt 132 extending from inflow section 110 toward posts 122.

Valve prosthesis 100 is preferably collapsible in order to facilitatetranscatheter delivery. Preferably, valve prosthesis 100 can bedelivered via a transfemoral approach. Valve prosthesis 100 can also bedelivered, however, by other transvascular approach methods or atransapical approach. Valve prosthesis 100 can also be implanted by openheart surgery or related methods. The valve prosthesis 100 can expandradially upon delivery at a target site. The target site is preferablythe native aortic annulus of a subject, but it is understood that valvesaccording to the present invention could be implanted at other positionsin a subject (e.g., a native mitral or pulmonary annulus).

For example, distal tip of a catheter sheath containing prosthesis 100can be inserted into a patient's vasculature (e.g., via a body lumensuch as a femoral artery) and advanced (along a guide wire, if provided)to the position of a native annulus. The native leaflets of the annuluscan be in place at the time of implantation of prosthesis 100, or can bepartially or completely removed prior to implantation. An outer tube ofthe catheter can be withdrawn some distance to expose a proximal portionof proximal skirt 132. The proximal portion can be positioned so as toabut against the ventricular side of the aortic annulus. If provided,barbs 134 can be primary contact points of prosthesis 100 with aninterior of a valve retaining sleeve, thereby reducing friction thatcould be caused by the inner surface of the valve retaining sleevesliding over prosthesis 100 while prosthesis 100 moves with respect tothe catheter sheath. Once it is determined that prosthesis 100 isproperly positioned in the annulus, the outer tube can be fullywithdrawn, releasing valve prosthesis 100 and allowing radial expansionof valve prosthesis 100 to engage the annulus. If, after partialrelease, it is determined that the prosthesis is not properlypositioned, the inflow section 110 can be recaptured into the outer tubefor repositioning.

Prosthesis support structure 130 can be made of a self-expandingmaterial, e.g., nitinol, thus tending toward a fully expanded positionthat is sufficient to securely engage the native annulus. When inposition within a patient, this tendency creates a radial force betweenprosthesis support structure 130 and the patient's anatomy, thus helpingto hold valve prosthesis 100 in place. The pressure applied by theprosthesis support structure 130, however, need not be sufficient byitself to anchor the prosthesis 100 in the native annulus. Furtherinhibiting migration of valve prosthesis 100 can be axial support anus128, which protrude over the tips of the native leaflets to provideaxial support to valve prosthesis 100 and to prevent valve prosthesis100 from being forced into the ventricle through the native leafletsduring the cardiac cycle. Support arms 128 can take on a variety ofconfigurations. Further, as detailed above, inflow section 110 canengage the ventricle below the inflow end of the native annulus,providing additional anchoring.

Support arms 128 can, for example, be configured to be at leastpartially disposed within aortic sinuses of the subject, and, for someapplications, to engage and/or rest against floors of the aorticsinuses, and to apply an axial force directed toward a left ventricle ofthe subject. Support arms 128 can meet one another at junctures. Forapplications in which each of support arms 128 is fabricated as aseparate piece, the support aims can be mechanically engaged to oneanother where they meet at the junctures. For some applications, supportarms 128 meet one another without actually touching one another, andinstead meet via an area defined at each juncture. Typically, thesupport arms are configured to define peaks at the junctures, andtroughs between adjacent peaks. U.S. application Ser. No. 11/728,253,filed Mar. 23, 2007, and U.S. application Ser. No. 11/726,889, filedMar. 23, 2007 detail various support arm configurations, and each isincorporated by reference herein in its entirety.

In some exemplary embodiments, valve prosthesis 100 includes three posts122, arranged circumferentially around a central longitudinal axis ofvalve prosthesis 100, and a flared portion extending in a proximaldirection from posts 122. In some exemplary embodiments, valveprosthesis 100 includes more or fewer than three posts 122, such as, forexample, two posts 122, or four posts 122. Approximately 90% of humanshave exactly three aortic sinuses. The three posts 122 provided in someexemplary embodiments correspond to these three aortic sinuses. Forimplantation in the approximately 10% of patients that have exactly twoaortic sinuses, valve prosthesis 100 can include only two posts 122.

Valve prosthesis 100 can also include a valve 150 coupled to posts 122.Valve 150 can be formed of a pliant material configured to collapseinwardly (i.e., towards the central longitudinal axis of valveprosthesis 100) during diastole, in order to inhibit retrograde bloodflow, and to open outwardly during systole, to allow blood flow throughvalve prosthesis 100. Valve 150 can be formed of artificial or naturaltissue. For example, valve 150 can be formed of bovine or porcinepericardium, or of any suitable synthetic material.

FIG. 2 is a perspective view of valve prosthesis 100 in an expandedstate, wherein no inward radial pressure or interference is applied toinflow section 110. In this expanded state, inflow section 110 has adiameter ID2, and outflow section 120 has an outflow diameter OD2. FIG.1 is a perspective view of a valve prosthesis 100 that is subject toinward radial pressure or interference at inflow section 110. Dependingon the geometry of a particular subject's annulus, inflow section 110will often be in at least a somewhat compressed position as shown inFIG. 1 due to the radial interference at inflow section 110. In thisposition, outflow section 120 has an outflow diameter OD1 that is largerthan OD2, causing posts 122 to be positioned farther from one anotherthan in a relaxed state. In other words, the outflow diameter of valveprosthesis 100 at outflow section 120 and the positioning of posts 122are affected by radial interference on valve prosthesis 100 at inflowsection 110, which can result in decreased performance characteristicsof valve prosthesis 100.

Decoupling of radial motion of outflow section 120 from radialinterference at inflow section 110 can produce significant benefits byproviding more predictable and stable valve geometry regardless ofpatient-specific anatomy.

FIG. 3 is a perspective view of a valve prosthesis 300 according to anembodiment of the present invention. FIG. 4 is a top schematic view ofvalve prosthesis 300. The basic structure of valve prosthesis 300 isgenerally similar to valve prosthesis 100. Valve prosthesis 300 includesan inflow section 310 at a proximal end thereof, and an outflow section320 at a distal end thereof. Valve prosthesis support structure 330includes posts 322 proximate to outflow section 320, and a proximalskirt 332 extending from inflow section 310 towards posts 322. Valveprosthesis 300 also includes a valve prosthesis support structure 330.

Valve prosthesis 300 further includes a motion limiting member 324.Motion limiting member 324 includes a substantially rigid circular framedisposed around outflow section 320. The substantially rigid circularframe preferably substantially maintains its shape even when subjectedto outside forces such as can be present within a body lumen of apatient. The substantially rigid circular frame can be made of, forexample, the types of surgical steel traditionally used for making stentdevices. Motion limiting member 324 can be mounted to valve prosthesissupport structure 330 by being attached to distal ends of posts 322. Insuch a configuration, motion limiting member 324 prevents divergence ofposts 322 by limiting the maximum diameter of outflow section 320,thereby preventing motion of posts 322 beyond the limits imposed bymotion limiting member 324. Motion limiting member 324 can beconstructed of a variety of materials, for example, nitinol.

The rigid circular frame of motion limiting member 324 can, however, besufficiently flexible to be compatible with collapse of valve prosthesis300 during an insertion process.

The rigid circular frame of motion limiting member 324 can alternatelyor additionally be mounted to valve prosthesis support structure 330 bybeing attached to proximal ends of posts 322, or at intermediatepositions of posts 322, in between proximal and distal ends.

Because the diameter of outflow section 320 is limited by motionlimiting member 324, the diameter of outflow section 320 is notsubstantially affected by changes in the diameter of inflow section 310,thereby decoupling radial motion of outflow section 320 from radialinterference at inflow section 310. Thus, valve prosthesis 300 maintainspredictable and stable valve geometry regardless of patient-specificanatomy.

FIG. 5 is a perspective view of a valve prosthesis 500 according to anexemplary embodiment of the present invention. FIG. 6 is a sideschematic view of valve prosthesis 500. Description of elements of theembodiment depicted in FIGS. 5 and 6 that are the same or operatesimilarly as the embodiments described above may be omitted orabbreviated.

Valve prosthesis 500 includes an inflow section 510 at a proximal endthereof, and an outflow section 520 at a distal end thereof. Valveprosthesis 500 also includes a valve prosthesis support structure 530,and a motion limiting member 524. Valve prosthesis support structure 530includes posts 522 proximate to outflow section 520, and a proximalskirt 532 extending from inflow section 510 toward posts 522.

Motion limiting member 524 includes rigid arches disposed proximate tooutflow section 520. Each rigid arch is mounted to valve prosthesissupport structure 530 by being attached to proximal ends of two adjacentposts 522. In this way, the rigid arches of the motion limiting member524 together extend around outflow section 520. In such a configuration,motion limiting member 524 prevents divergence of posts 522 by limitingthe diameter of outflow section 520, thereby preventing motion of posts522 beyond the limits imposed by motion limiting member 524.

In some embodiments, the rigid arches of motion limiting member 524 cantogether form a circular shape, or can form another shape, such as, forexample, a series of linked “humps” connecting around outflow section520.

In some embodiments, the rigid arches of motion limiting member 524 aresufficiently flexible to collapse with valve prosthesis 500 during aninsertion process.

In some embodiments, the rigid arches of motion limiting member 524 aremounted to valve prosthesis support structure 530 by being attached todistal ends of posts 522, or at intermediate positions of posts 522, inbetween proximal and distal ends.

In some embodiments, the rigid arches of motion limiting member 524 canextend out from valve prosthesis support structure 530 at a 90 degreeangle with respect to a longitudinal axis extending through valveprosthesis 500. Alternatively, the rigid arches of motion limitingmember 524 can extend from valve prosthesis support structure 530 at anangle other than 90 degrees, such as, for example, approximately 30degrees, approximately 45 degrees, or approximately 120 degrees.Moreover, each rigid arch need not extend out from valve prosthesissupport structure 530 at the same angle as other rigid arches.

In some embodiments multiple rigid arches can extend between adjacentposts 522. Intermediate connections can be formed between adjacent rigidarches such that the rigid arches extending between adjacent posts 522are connected in series.

Because the diameter of outflow section 520 is limited by motionlimiting member 524, it is not substantially affected by radialinterference (i.e., changes in diameter) at inflow section 510, therebyachieving decoupling of radial motion of outflow section 520 from radialinterference at inflow section 510. Thus, valve prosthesis 500 maintainspredictable and stable valve geometry regardless of patient-specificanatomy.

FIG. 7 is a perspective view of a valve prosthesis 700 according to anembodiment of the present invention. FIG. 8 is a side schematic view ofvalve prosthesis 700. Description of elements of the embodiment depictedin FIGS. 7 and 8 that are the same or operate similarly as theembodiments described above may be omitted or abbreviated.

Valve prosthesis 700 includes an inflow section 710 at a proximal endthereof, and an outflow section 720 at a distal end thereof. Valveprosthesis 700 also includes a valve prosthesis support structure 730,and a motion limiting member 724.

Valve prosthesis support structure 730 includes posts 722 proximate tooutflow section 720, and a proximal skirt 732 extending from posts 722toward inflow section 710.

Motion limiting member 724 includes linear support elements disposedproximate to outflow section 720. Each linear support element is mountedto valve prosthesis support structure 730 by being attached to distalends of two adjacent posts 722. In this way, the linear support elementsof motion limiting member 724 together link posts 722. In such aconfiguration, motion limiting member 724 prevents divergence of posts722 by limiting the diameter of outflow section 720, thereby preventingmotion of posts 722 beyond the limits imposed by motion limiting member724.

In some embodiments the linear support elements of motion limitingmember 724 are non-rigid and act only in tension. For example, suchlinear support elements can be made of string, wire, sutures, or thelike.

In some embodiments, the linear support elements of motion limitingmember 724 are rigid.

In some embodiments, the linear support elements of motion limitingmember 724 are mounted to valve prosthesis support structure 730 bybeing attached to proximal ends of posts 722, or at intermediatepositions of posts 722, in between proximal and distal ends.

In some embodiments multiple linear support sub-elements can extendbetween adjacent posts 722, with intermediate connections betweenadjacent linear support sub-elements such that the linear supportsub-elements extending between adjacent posts 722 are connected inseries.

Because the diameter of outflow section 720 is limited by motionlimiting member 724, it is preferably not substantially affected byradial interference (i.e., changes in diameter) at inflow section 710,thereby achieving decoupling of radial motion of outflow section 720from radial interference at inflow section 710. Thus, valve prosthesis700 maintains predictable and stable valve geometry regardless ofpatient-specific anatomy.

FIG. 9 is a perspective view of a valve prosthesis 900 according to anembodiment of the present invention. FIG. 10 is a side schematic view ofvalve prosthesis 900. Description of elements of the embodiment depictedin FIGS. 9 and 10 that are the same or operate similarly as theembodiments described above may be omitted or abbreviated.

Valve prosthesis 900 includes an inflow section 910 at a proximal endthereof, and an outflow section 920 at a distal end thereof. Valveprosthesis 900 also includes a valve prosthesis support structure 930,and a motion limiting member 926.

Valve prosthesis support structure 930 includes posts 922 proximate tooutflow section 920, and a proximal skirt 932 extending from inflowsection 910 toward posts 922.

Motion limiting member 926 includes strut support elements disposedproximate to inflow section 910. Each strut support element is mountedto a proximal end of inflow section 910, and extends between adjacentendpoints of proximal skirt 932. In this way, the strut support elementsof motion limiting member 926 together link endpoints of inflow section910. In such a configuration, motion limiting member 926 preventsdivergence of the endpoints of proximal skirt 932 by limiting thediameter of inflow section 910, thereby preventing motion of theendpoints of proximal skirt 932 beyond the limits imposed by motionlimiting member 926.

In some embodiments, multiple strut support elements can extend betweenadjacent endpoints of proximal skirt 932, with intermediate connectionsbetween adjacent endpoints of proximal skirt 932 such that the strutsupport elements extending between adjacent endpoints of proximal skirt932 are connected in series.

In some embodiments, the strut support members of motion limiting member926 are incorporated in and form a part of proximal skirt 932 such thatmotion limiting member 926 and proximal skirt 932 are formed togethermonolithically.

In some embodiments, the strut support members of motion limiting member926 are rigid. In some embodiments, the strut support members of motionlimiting member are non-rigid.

Because the diameter of inflow section 910 is limited by motion limitingmember 926, its motion due to valve function and cardiac contraction canbe confined to within limits necessary for proper functioning, therebyeliminating or reducing unnecessary radial movement. Reducing thisunnecessary radial movement in turn reduces the fatigue that valveprosthesis 900 is subject to, thereby extending its useful life, andeliminating the need for subsequent replacement of valve prosthesis 900or reducing the frequency with which valve prosthesis 900 must bereplaced to maintain proper functionality. Additionally, because motionlimiting member 926 limits the diameter of inflow section 910, valveprosthesis 900 maintains more predictable and stable valve motion andvalve geometry regardless of patient-specific anatomy. Further,stabilizing the diameter of inflow section 910 results in lessdeformation (i.e., changes in diameter) of outflow section 920.

FIG. 11 is a perspective view of a valve prosthesis 1100 according to anembodiment of the present invention. Description of elements of theembodiment depicted in FIG. 11 that are the same or operate similarly asthose described above may be omitted or abbreviated.

Valve prosthesis 1100 includes an inflow section 1110 at a proximal endthereof, and an outflow section 1120 at a distal end thereof. Valveprosthesis 1100 also includes a valve prosthesis support structure 1130,and sealing members 1142.

Valve prosthesis support structure 1130 includes posts 1122 proximate tooutflow section 1120, and a proximal skirt 1132 extending from posts1122 toward inflow section 1110.

Sealing members 1142 can be disposed proximate to inflow section 1110,and can be positioned to correspond radially with posts 1122. Suchpositioning corresponds to native commissures, and aligns sealingmembers 1142 with a patient's inter-leaflet triangles. Sealing members1142 can be shaped so as to fit into the inter-leaflet triangles, or canbe formed of a material that conforms to the shape of the inter-leaflettriangles upon being placed in contact with the inter-leaflet triangles.In this way, sealing members 1142 help valve prosthesis 1100 attain ahigh level of conformance to the patient's annular anatomy, therebypreventing or reducing the chance and severity of paravalvular leakage.U.S. application Ser. No. 13/091,765, filed. Apr. 21, 2011, discussessealing members for use with prosthetic valves, and is incorporated byreference herein in its entirety.

FIG. 12 is a perspective view of a valve prosthesis 1200 according to anembodiment of the present invention. Description of elements of theembodiment depicted in FIG. 12 that are the same or operate similarly asthose described above may be omitted or abbreviated.

Valve prosthesis 1200 includes an inflow section 1210 at a proximal endthereof, and an outflow section 1220 at a distal end thereof. Valveprosthesis 1200 also includes a valve prosthesis support structure 1230,and a sealing member 1242.

Valve prosthesis support structure 1230 includes posts 1222 proximate tooutflow section 1220, and a proximal skirt 1232 extending from posts1222 toward inflow section 1210.

Sealing member 1242 can be disposed proximate to inflow section 1210,and can extend around the circumference of proximal skirt 1232. Sealingmember 1242 can include sealing tips 1244 positioned to correspondradially with posts 1222. Such positioning corresponds to nativecommissures, and aligns sealing tips 1244 with a patient's inter-leaflettriangles. Sealing tips 1244 can be shaped so as to fit into theinter-leaflet triangles, or can be formed of a material that conforms tothe shape of the inter-leaflet triangles upon being placed in contactwith the inter-leaflet triangles. In this way, sealing member 1242,including sealing tips 1244, helps valve prosthesis 1200 attain a highlevel of conformance to the patient's annular anatomy, therebypreventing or reducing the chance and severity of paravalvular leakage.

In some embodiments, sealing member 1242 including sealing tips 1244 isformed of a single material. In some embodiments, sealing tips 1244 areformed of a material different from the balance of sealing member 1242.For example, sealing tips 1244 can be formed of a soft material capableof conforming to the patient's inter-leaflet triangles, while thebalance of sealing member 1242 can be formed of a more rigid material.

In some embodiments, sealing member 1242 acts as a motion limitingmember, and limits the diameter of inflow section 1210, therebypreventing motion of endpoints of proximal skirt 1232 beyond limitsimposed by sealing member 1242. In this way, sealing member 1242 issimilar to motion limiting member 926.

While various embodiments of the present invention have been describedabove, they have been presented by way of example only, and notlimitation. The elements of the embodiments presented above are notnecessarily mutually exclusive, but can be interchanged to meet variousneeds as would be appreciated by one of skill in the art.

It therefore will be apparent to one skilled in the art that variouschanges in form and detail can be made to the embodiments disclosedherein without departing from the spirit and scope of the presentinvention. The phraseology or terminology herein is used for descriptionand not for limitation. Thus, it is intended that the present inventioncover modifications and variations of this invention provided they comewithin the scope of the appended claims and their equivalents.

1-30. (canceled)
 31. A prosthesis comprising: an inflow section; anoutflow section; a collapsible and expandable support structure, thesupport structure including a plurality of posts proximate the outflowsection and a proximal skirt extending from the plurality of poststowards the inflow section; a valve coupled to the plurality of posts;and a plurality of sealing members coupled to the proximal skirt, eachof the plurality of sealing members longitudinally aligned with acorresponding one of the plurality of posts.
 32. The prosthesis of claim31, the plurality of sealing members being shaped to conform tointer-leaflet triangles of a patient's heart.
 33. The prosthesis ofclaim 31, wherein the plurality of leaflets are formed of a materialthat conforms to a shape of interleaflet triangles of a patient's heart.34. The prosthesis of claim 31, further comprising a plurality ofsupport arms extending from the plurality of posts towards the inflowsection, wherein the supports arms are disposed radially outward of theproximal skirt.
 35. The prosthesis of claim 34, wherein the plurality ofsupport arms are configured to extend over tips of native leaflets of apatient's native valve.
 36. The prosthesis of claim 35, wherein theplurality of support arms comprises three support arms and the pluralityof posts comprises three posts, wherein a first end of a first supportarm of the three support arms is coupled to a first post of the threeposts and a second end of the first support arm is coupled to a secondpost of the three posts, a first end of a second support art of thethree support arms is coupled to the second post and a second end of thesecond support arm is coupled to a third post of the three posts, and afirst end of the third support arm of the three support posts is coupledthe second post and a second end of the third support arm is coupled tothe first post.
 37. The prosthesis of claim 31, wherein the proximalskirt comprises a plurality of rows of cells.
 38. A prosthesiscomprising: an inflow section; an outflow section; a collapsible andexpandable support structure, the support structure including aplurality of posts proximate the outflow section and a proximal skirtextending from the plurality of posts towards the inflow section; avalve coupled to the plurality of posts; and a sealing member proximatethe inflow section, wherein the sealing member extends around acircumference of the proximal skirt, wherein the sealing member includesa plurality of sealing tips that are longitudinally aligned with theplurality of posts and extend toward the outflow section of theprosthesis, wherein the sealing member is shaped and configured toconform to inter-leaflet triangles of a patient's heart.
 39. Theprosthesis of claim 38, wherein the sealing tips are formed of a firstmaterial and a remainder of the sealing member is formed of a secondmaterial different than the first material.
 40. The prosthesis of claim39, wherein the first material is softer than the second material. 41.The prosthesis of claim 38, further comprising a plurality of supportarms extending from the plurality of posts towards the inflow section,wherein the supports arms are disposed radially outward of the proximalskirt.
 42. The prosthesis of claim 41, wherein the plurality of supportarms are configured to extend over tips of native leaflets of apatient's native valve.
 43. The prosthesis of claim 42, wherein theplurality of support arms comprises three support arms and the pluralityof posts comprises three posts, wherein a first end of a first supportarm of the three support arms is coupled to a first post of the threeposts and a second end of the first support arm is coupled to a secondpost of the three posts, a first end of a second support art of thethree support arms is coupled to the second post and a second end of thesecond support arm is coupled to a third post of the three posts, and afirst end of the third support arm of the three support posts is coupledthe second post and a second end of the third support arm is coupled tothe first post.
 44. The prosthesis of claim 38, wherein the proximalskirt comprises a plurality of rows of cells.